(TC30) Late Management of Avulsed Central Incisors Associated with Complicated Alveolar Fracture

Abstract: The prognosis of avulsed teeth depends primarily on the extra-oral time and stage of root development. Presenting with avulsed teeth with more than one hour of extra-oral time will likely result in tooth ankylosis. While this outcome may still be favorable compared to losing anterior teeth, managing these teeth can be more complicated when there is a total collapse of the buccal plate and fracture of the anterior maxilla. In this table clinic, we present the management of a complex alveolar fracture associated with two avulsed central incisors in a 30-year-old female patient. The extra-oral time was over 11 hours, and CBCT imaging showed a collapsed buccal plate and fracture of the anterior maxilla. Due to the extensive extra-oral time, endodontic treatment was performed extra-orally on the two central incisors, followed by mucoperiosteal flap elevation, removal of the fractured fragments of the buccal plate, reinsertion of the teeth in place, and re-establishment of the buccal plate using guided tissue regeneration. Teeth were splinted in place using a semi-rigid splint. Follow-up showed primary stability of the teeth and acceptable soft tissue remodeling. The approach presented herein shows complex management of avulsion and alveolar fracture with a primary aim to restore esthetics and a long-term goal to preserve the alveolar ridge for late-stage implant placement.